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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496890095
Report Date: 10/07/2025
Date Signed: 10/07/2025 05:55:34 PM

Document Has Been Signed on 10/07/2025 05:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ALLURE SENIOR CAREFACILITY NUMBER:
496890095
ADMINISTRATOR/
DIRECTOR:		SHAUGHNESSEY, MERAFACILITY TYPE:
740
ADDRESS:2008 DENNIS LANETELEPHONE:
(707) 843-4090
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 6CENSUS: 6DATE:
10/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lorena Madrigal- Administrator AssistantTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 10/7/2025 at approximately 10:00am, and met with Administrator Assistant, Lorena Madrigal. Administrator Mera Shaughnessey would arrive later after their scheduled morning appointment.

There currently are six (6) residents residing in the facility; One (1) resident is currently hospitalized. Fire clearance is approved for six (6) non-ambulatory/bedridden residents, Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required.

Per record reviews, the facility conducted their last emergency disaster quarterly drill on April 4th & 5th, 2025. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements.

LPA observed eleven(11) of eleven(11) smoke alarms; Smoke alarm system is hardwired, and is a carbon monoxide detector as well. The smoke alarm system was working properly during the inspection.

LPA reviewed six (6) resident files. All files were complete. Two (2) residents are on hospice services.

The LPA reviewed four (4) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. LPA reviewed staff training.

Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ALLURE SENIOR CARE
FACILITY NUMBER: 496890095
VISIT DATE: 10/07/2025
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Continued from LIC809..

The LPA toured the facility with Administrator Assistant Lorena. Hot water was measured at 115.8 degrees Fahrenheit. All exit doors had auditory alarms, and the alarms were working properly during the inspection. Fire extinguishers, two (2) were serviced and tagged as required. There was sufficient food supply for perishable and non-perishable food; Assistant Administrator stated Tuesday is the facility's food shopping day, and additional supplies will be arriving today. There was a sufficient supply of cleaners/disinfectants, and these items were locked up and inaccessible to residents in care. There was a sufficient supply of linens, paper products, and furnishings. personal protective equipment (PPE). LPA observed sufficient lighting in resident rooms, bathrooms, hallways, and all common areas. Medications were locked up and inaccessible to residents in care. Medications needing refrigeration were in a small refrigerator in the key pad locked pantry room, making the medications inaccessible to residents in care. All resident rooms have private bathrooms, each of them have grab bars for resident use. Each resident's bathroom has a shower head for showering the resident, and the facility has a large roll-in shower room in the hallway for resident use if wanted. The large roll-in shower room has grab bars, and a bathing shower mat. Facility was at a comfortable temperature during the inspection. LPA observed majority of the residents up, and engaged with staff in the facility common areas; LPA observed the residents having their noon meal.

LPA is requesting the following documents be updated and submitted by 11/7/2025:

LIC308 - Designation of Administrator Responsibility
LIC500 - Personnel Report
LIC610E-Emergency Disaster Plan - (review and update as needed/required-submit if changes)
Infection Control Plan (review and update as needed/required-submit if changes)
Copy of LIC400- Handling of Client Cash Resources (include copy of surety bond if handling cash)
Copy of Current Liability Insurance
Resident Roster
Copy of current Administrator Certificate- (Mera Shaughnessey and Lorena Madrigal)

Continued on LIC809C..
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ALLURE SENIOR CARE
FACILITY NUMBER: 496890095
VISIT DATE: 10/07/2025
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Continued from LIC809C..

LPA observed the following deficiencies:

Residents' private bathrooms', six (6), with shower heads for bathing, all lack slip-resistant mats, strips, or flooring for residents use when bathing. Per staff interview, residents’ use their private bathrooms for bathing. This deficiency will be cited, 87303(e)(5) Maintenance and operation- Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors, see LIC809D.

Per record review. facility missed the third (3rd) emergency disaster drill of facility's required quarterly drills. Last drill was conducted April 4th & 5th, 2025. This deficiency will be cited, 1569.695(c)- A facility shall conduct a drill at least quarterly for each shift. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Appeal rights given to the Assistant Administrator.
Exit interview conducted with Administrator Assistant, Lorena Madrigal.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Dina Alviso
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2025 05:55 PM - It Cannot Be Edited


Created By: Dina Alviso On 10/07/2025 at 05:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ALLURE SENIOR CARE
FACILITY NUMBER: 496890095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(5)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Per LPA's observation, residents' private bathrooms, six (6), with shower heads for bathing, all lack slip-resistant mats, strips, or flooring for residents use when bathing. Per staff interview, residents’ use their private bathrooms for bathing, the licensee did not comply with the section cited above in [6] out of [6] private bathing/shower bathrooms, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2025
Plan of Correction
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Licensee to ensure that the facility provides each resident's private bathroom with a slip-resistant mat and/or strips for the shower room floor for residents' use. Provide written self certification of providing the required non-slip mats/strips for each bathroom (6) and receipt of purchase. POC due 10/13/25.
Type B
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review. facility missed the third (3rd) emergency disaster drill of facility's required quarterly drills , the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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Licensee to ensure all required emergency disaster quarterly drills are completed and documented as required. Licensee to submit written plan of facility's future compliance regarding the required emergency drills, to be held quarterly. Facility is conducting an October drill per record review, please ensure all staff attend, it is held on all shifts as required, and drills are documented as required. Submit POC by 10/17/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Dina Alviso
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2025


LIC809 (FAS) - (06/04)
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